CEFIZOX IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CEFIZOX IN PLASTIC CONTAINER (CEFIZOX IN PLASTIC CONTAINER).
Binds to penicillin-binding proteins (PBPs) in bacterial cell wall, inhibiting peptidoglycan cross-linking, leading to cell lysis and death.
| Metabolism | Not significantly metabolized; primarily eliminated unchanged via renal tubular secretion and glomerular filtration. |
| Excretion | Primarily renal (80-90% unchanged), with biliary/fecal elimination being minor (<10%) |
| Half-life | 1.5-2 hours; prolonged to 10-30 hours in severe renal impairment (CrCl <10 mL/min) |
| Protein binding | ~30-50%, primarily to albumin |
| Volume of Distribution | 0.15-0.3 L/kg; low Vd indicates limited tissue distribution, primarily extracellular fluid |
| Bioavailability | IM: 100% (complete absorption) |
| Onset of Action | IV: Immediate after bolus; IM: 30-60 minutes to peak serum concentrations |
| Duration of Action | 6-8 hours for susceptible bacteria; dosing interval 8-12 hours in normal renal function |
1-2 g IV/IM every 8-12 hours; severe infections: up to 2 g every 6-8 hours; maximum 12 g/day.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl 30-59 mL/min: dose q12h; CrCl 10-29 mL/min: dose q24h; CrCl <10 mL/min: dose q48h; hemodialysis: 1 g after each dialysis. |
| Liver impairment | No adjustment required for mild-to-moderate hepatic impairment; severe hepatic impairment with ascites or encephalopathy: monitor closely, dosing adjustment may be considered but no specific guidelines. |
| Pediatric use | Infants and children: 50-100 mg/kg/day IV/IM divided q6-8h; severe infections: up to 200 mg/kg/day; neonates: 50-100 mg/kg/day divided q12h. |
| Geriatric use | Initiate at lower end of dosing range; adjust based on renal function (CrCl); monitor for adverse effects due to age-related renal decline. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CEFIZOX IN PLASTIC CONTAINER (CEFIZOX IN PLASTIC CONTAINER).
| Breastfeeding | Ceftizoxime is excreted in human milk in low concentrations. The milk-to-plasma ratio is approximately 0.1. It is considered compatible with breastfeeding; however, caution should be exercised due to potential alteration of infant gut flora and risk of sensitization. |
| Teratogenic Risk | Pregnancy Category B. Animal studies have not demonstrated teratogenic effects. There are no adequate and well-controlled studies in pregnant women. Caution is advised in the first trimester due to theoretical risks, but no known fetal harm has been reported. |
■ FDA Black Box Warning
None
| Serious Effects |
["Hypersensitivity to ceftizoxime or other cephalosporins"]
| Precautions | ["Hypersensitivity reactions including anaphylaxis","Clostridium difficile-associated diarrhea (CDAD)","Seizures in patients with renal impairment","Coagulation disorders (due to vitamin K inhibition)"] |
| Food/Dietary | Avoid alcohol-containing foods, beverages, or medications during therapy and for 3 days after stopping to prevent disulfiram-like reaction (nausea, vomiting, flushing, headache). |
| Clinical Pearls |
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| Fetal Monitoring | Monitor renal function and complete blood count periodically during prolonged therapy. Assess for signs of hypersensitivity reactions. In neonates, monitor for diarrhea and candidiasis. |
| Fertility Effects | No specific studies on human fertility. Animal studies have not shown adverse effects on fertility or reproductive performance. |
| For IV administration, infuse over 30 minutes to avoid thrombophlebitis. Adjust dose in renal impairment (CrCl <50 mL/min). Can cause positive Coombs test without hemolysis. Not active against MRSA or Enterococcus. Cross-allergenicity with penicillins possible (beta-lactam). |
| Patient Advice | Take exactly as prescribed; complete full course even if you feel better. · Report any signs of allergic reaction (rash, itching, swelling, difficulty breathing) immediately. · May cause diarrhea; contact your doctor if severe or bloody. · Avoid alcohol during treatment and for 72 hours after last dose to prevent disulfiram-like reaction. · Inform your doctor if you have kidney disease or if you are pregnant/breastfeeding. |